Muscle Injuries in Sports

Muscle injuries account for about 30% of all sports injuries. The importance of these minor injuries is often underestimated. If not healed properly, muscles injuries may lead to major injuries. The consequences are long breaks from training and competitions, and possible permanent damages.

 

Wie kommt es zu Zerrung, zum Muskelfaserriss und anderen Muskelverletzungen?

Der menschliche Körper verfügt über mehr als 300 voneinander abgrenzbare Einzelmuskeln, die zusammen etwa 40% der gesamten Körpermasse ausmachen. Eine intensive Beanspruchung der Muskulatur, einhergehend mit Erschöpfung, unzureichender Sauerstoff-, Flüssigkeit- und Elektrolytzufuhr bringt den Muskel-Stoffwechsel aus der Balance, ebenso die Kommunikation zwischen Muskulatur und Nervenbahnen. Folgt dann noch eine ungewohnte, ruckartige Bewegung, wird der Muskel über das physiologische Maß hinweg gedehnt – und eine Zerrung ist die Folge. Häufig spüren Sportlerinnen und Sportler nur ein leichtes Ziehen. Ignoriert man diese Symptome und belastet den strapazierten Muskel weiter, können Muskelfasern reißen, und ein stechender Schmerz schießt in den Muskel – an eine Fortsetzung der sportlichen Aktivität ist jetzt definitiv nicht mehr zu denken. Diagnose: Muskelfaserriss.

Bei sportlichen Aktivitäten steigt das Verletzungsrisiko durch:

• unzureichendes Aufwärmen und Stretching
• falsche Trainingsmethoden
• Muskelübermüdung
• Überbelastung
• muskuläre Dysbalancen (meist Muskelverkürzung)

Wie lange kann ich nach einer Muskelverletzung keinen Sport machen?

Die Heilungsphase nach Muskelverletzungen richtet sich nach der Schwere der Verletzung. Man unterscheidet:

• Muskelkater
• Muskelzerrung
• Muskelfaserriss
• Muskelriss
• Muskelkrampf
• Muskelprellung

Der Heilungsprozess kann durch medizinische und physiotherapeutische Maßnahmen unterstützt werden. Ganz besonders wichtig für einen optimierten Heilungsprozess sind jedoch unterstützende aktive Maßnahmen des Sportlers sowie ein gut geplanter, vernünftiger Trainingsaufbau. Nach einer Muskelverletzung sollte ein Sportler grundsätzlich erst nach vollständiger Beendigung des Heilungsprozesses wieder an Wettkämpfen teilnehmen, also erst dann, wenn er auch während intensivem körperlichen Training beschwerdefrei bleibt.

Im Folgenden werden die wichtigsten Muskelverletzungen im Sport, deren Symptome, Ursachen und wichtige Therapieansätze vorgestellt.

Die Heilungsdauer nach Muskelverletzungen richtet sich nach der Schwere der Verletzung. Sie läuft grundsätzlich immer in drei Phasen ab.
In der ersten Phase kommt es nach Riss der Muskelfasern zur Ausbildung eines Blutergusses, eines intra- oder intermuskulären Hämatoms im Defektbereich. In der sich anschließenden Reparationsphase werden die verletzten Gewebeanteile abgebaut und es bilden sich neue Blutgefäße und Kollagenfasern, sodass eine stabile Narbe entsteht. Darauf folgt die Wiederherstellungsphase in der sich die Kollagenfaserstruktur wieder normalisiert und die unflexible Narbe wieder an Elastizität gewinnt.
Im Folgenden werden die wichtigsten Muskelverletzungen im Sport, deren Symptome, Ursachen und wichtige Therapieansätze vorgestellt.

Sore muscles and stiffness

Symptoms

Diffuse muscle pain usually occur one to two days after unaccustomed or excessive exercises or physical work. Muscles ache for about one week even with only light work or exercises. Sore, stiff muscles are usually healing within a week of normal activities without resulting in an injury.

Causes

Sports activities/training not accustomed to, excessive training, especially after power training or sudden stop and go movements; unusual, new movements especially those that exert force due to poor intramuscular coordination. Contrary to what was previously suspected, the in the muscle remaining lactic acid (lactate) is not responsible, but rather micro-injuries in the ultra-structure of muscle fibers (actin-myosin). Sore or stiff muscles can lead to a temporary loss of power for up to 30%.

Therapy

Light/slow training without quick and complicated moves, heat wraps to stimulate the blood circulation, saunas, and/or electrical therapy in the form of iontophoresis to improve circulation. Massages in the acute pain phase do not make sense. Only after acute pain, a mild relaxation massages in combination with heat might be beneficial.

Muscle Strain

Symptoms

Slowly developing pain during exercise in localized muscle sections with increasing complaints at increasing exposure time, ending in cramping pain; stretching the affected muscle results in clearly defined pain.

Causes

Mostly lack of proper preparation (warm-up, stretching, etc.), exposure to intense stress and strain (local fatigue), muscle imbalances, improper training structure or mineral loss through excessive sweating can cause a localized, painful increase of muscle tension. The continuity of the muscle fibers is retained, the limits of their expansion elasticity is reached, but not exceeded, no injury-related bleeding, palpable defect in the muscles.

Therapy

Stop sports activities immediately, start cooling treatment to relieve pain and reduction of muscle tonus; optimal: mild cold, for example compression bandages soaked in ice water (hot ice) or special cooling ointments. Attention - do not directly apply ice or ice sprays, since this can lead to severe hypothermia or tissue damage. Follow-up with well-dosed stretching for 3-5 days, take a break from training and competitions. Starting on the first day metabolic stimulation, for example light running or bike ergometer training; follow-up with stretching exercises. Please note: weight loading only in pain-free areas, no forceful movements; accompanying massage, electrotherapy, heat, possibly magnesium intake, possibly injections of homeopathic or biological drugs.

Torn Muscle Fiber

Symptoms

Stabbing like pain in the muscles, without forewarning; typically plyometric-stress (sprint or jumping events, ball games, etc.) especially in case of sudden stopping and braking (eccentric load), rapid acceleration (concentric load) or a combination of both. Muscle fifer pops up with accompanying bleeding into the muscles (hematoma); more or less depending on the severity, palpable big dent in the muscle.

Causes

Mostly lack of proper preparation (warm-up, stretching, etc.), exposure to intense stress and strain (local fatigue), muscle imbalances, improper training structure or mineral loss through excessive sweating can cause a localized, painful increase of muscle tension. The continuity of the muscle fiber is retained, the limits of their expansion elasticity is reached, but not exceeded, no injury-related bleeding, palpable defect in the muscles.

Diagnosis

Comprehensive clinical examination, ultra sound or MRT.

Therapy

Terminate sports activities immediately, immediate cooling treatment to relieve pain and reduction of muscle tonus; optimal: mild cold, for example wide compressions (bandages soaked in ice water or special cooling ointments). To avoid severe hypothermia or tissue damage, remove compression bandage after 20 minutes; wait 5 minutes than reapply the compression. Repeat four or five times. After this apply cooling ointment compression bandage (Do not wrap too tightly.) and leave for several hours. Elevate injured muscle area above the heart region and do not strain. If necessary, take anti-inflammatory drugs (diclofenac, ibuprofen, enzymes, etc.). In most cases there should be a break from training and any participation in sports/competitions for at least. Following is an intensive aftercare with the aim to keep the muscle scar as small as possible, however resistant to stress. This means initially intensive physiotherapy with lymphatic drainage and electrotherapy to local swelling, gentle massage of the surrounding muscles to reduce of muscle tonus, mobilization of the surrounding joints, possibly local infiltration treatment with homeopathic or biological drugs, possibly relieving dressings, bandages etc. From about the 5th day first light active training such as jogging, bicycle ergometer for metabolic activation and slight stretching. Load should be increased slowly within a pain-free range. First mild plyometric training should not take place any earlier than 3 weeks after the injury, otherwise there is a high chance for re-injury.

Muscle bundle/fascicle tear / Muscle tear

Symptoms

Acute injury marked by very strong pain, symptoms similar to a torn muscle fiber, but generally much more pronounced. Palpable disruption of muscle continuity during complete muscle rupture (tear Grade 3 / muscle tear), complete separation of the bulging area in the muscle, possibly visible tumor-like swelling, in as much as the muscle is constrained toward the tendon.

Causes

Direct impact trauma in contact sports, more frequently occurring after taking anabolics.

Diagnosis

Ultrasound, if necessary, magnetic resonance imaging (MRI) scan to accurately assess and to detect secondary injuries is required.

Therapy

Depending on the affected muscle(s), severity of injury, age and ambitions of the athlete, the restoring of full functionality is typically only possible through surgery. Otherwise the therapy is similar to the one for a torn muscle fiber. Possible complications can be bone formation in the injured muscles (myositis ossificans), functional deficit.

Muscle cramps

Symptoms

Acute painful involuntary contraction and awkward posture of the affected muscle sections, active voluntary movement is impossible. Dysfunction occurs more frequently at night.

Causes

Electrolyte loss through excessive sweating without adequate fluid and mineral supply, overloading, especially the calf muscles by foot deformities, improper footwear, insufficient orthotics, circulation problems created by too tight bandages, muscle imbalance.

Therapy

Immediate stretching, cold therapy, possibly ointment bandages, adequate fluids and minerals supply, treatment of the possible orthopedic defects (foot deformity, difference in leg length, muscular dysbalance). Prevention through adequate fluid intake during exercise, and intensive cooling down and stretching immediately after exercise.

Muscle Contusion ("dead leg")

Symptoms

Large bruised muscle area in combination with pain, sensitive to contact and pressure, possibly swelling or fluctuation, later visible bruising. Exact extent of the injury only sonographically identified; pronounced intramuscular hemorrhage are possible; compartment syndrome as a most serious complication may necessitating surgical intervention.

Causes

The muscle is crushed against the bone through direct external forces, such as direct blows or impacts, etc. This can cause a tissue contusion with hemorrhaging inside the muscles. Responsible is often inadequate protective clothing.

Therapy

Depending on the severity, any sports activities should be discontinued for a few days. In injured leg muscles, the leg should be elevated and be treated with cold packs, and if necessary a compression bandage should be applied. Medicinal treatment should be ointments that reduce the swelling and anti-inflammatory medication, possibly early electrotherapy for edema resorption and lymphatic drainage.

What is essential for an optimal healing of a muscle injury?

Decisive for an optimal healing is firstly an accurate diagnosis. Basically the treatment includes the following essential measures:

•     active measures taken by the patient
•     physiotherapy
•     medicinal therapy
•     adequate controlled training

Regarding drug therapy, it is differentiated between ointments, tablets and injection treatments. Preferential for athletes are injection treatments with homeopathic medicines (as Traumeel) or autologous blood (ACP) for the support and acceleration of the healing process.

After a muscle injury, athletes should only participate again in competitions after full healing/recovery process, meaning only when there are no symptoms during intensive training.

Who specializes in the treatment of muscle injuries?

The orthopedic team at the KLINIK am RING specializes in the treatment of all sports injuries, conditions, and diseases. The team relies on a founded expertise and comprehensive experiences and also offer consultation on professional treatment options and methods to amateur athletes.